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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />LoJ(*|kDate(s):1. <br />2. <br />Address: <br />Phone:) <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />I <br />Approved water tor drinking, utensil and hand washing will he provided in my booth by the following methods: <br /> Approved bottled water. <br />7. <br />8. <br />SAN JOAQUIN <br />COUNTY— <br /> A booth with waifs and ceiling constructed of either wood, canvas, pfastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Other (specify): pJ ft _______________ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />4^0 Aef/ <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www siqov orq/ehd <br />Page 7 <y -i i T fMP hVtNT APP <br /> On-site hose bib that is connected to a potable water source. <br />0 Other (specify): <br />Electricity is provided for my booth's use: Q Yes Q No <br />I am providing an accurate probe thermometer {o' measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: [£] Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Q Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Alternate: ( <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: Yes [^] No 11 <br />All food is prepared on-site or is from approved commercial facilities: Yes [^No <br />Name of facility: Q> Phone: (L>?) <br />Address of facility:_ 1^44 Lr>. bJi err <br />I am providing a booth with the following, (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: ^kpoK S Hb-Vh firihMoA Mam Dccj <br />The following is information about my organizalionJbusiness: <br />Name of organization/business:. PiAri't CtotAe Co. <br />Ln <br />(7^ i